Main page > Vol-15 No-1 > Book001 LinkedIn WhatsApp X (Twitter) Facebook Copy link Anil Aggrawal's Book Review Journal Volume-1, Number-1 ( July - December ) Book Review (Technical Section) Basic Sciences as applied to Forensic Medicine and Toxicology By Anil Aggrawal A forensic masterclass in basic sciences for postgraduates. The current book by the Author is an attempt- novel and unique, in the sense that the effort is inspired by the Indian post-graduate curriculum designed by the erstwhile Medical Council of India (known as National Medical Commission now) for M.D. course in the discipline of Forensic Medicine, more specifically the Paper-I of the Theory examination. The import of the title “Basic Sciences as Applied to Forensic Medicine and Toxicology” is very wide in scope and pertains to all the relevant anatomy, biochemical and physiologic principles, etc which is the basis of understanding the morbid anatomy and application of those to better understand the core Forensic Pathology. The book is an attempt to provide a one stop solution to the postgraduates in the discipline who earlier had to scroll through voluminous texts of Anatomy, Physiology, Biochemistry, etc to derive examination oriented content for better presentation in the examinations. Although the relevant basic sciences applicable to particular topics of interest in Forensic Medicine have already been provided by the Author in his earlier books viz. Textbook of Forensic Medicine & Toxicology, Injuries- Forensic and Medico Legal Aspects and Clinical and Forensic Toxicology, the present book goes several leaps ahead to explain most commonly asked topics from the entire ream of basic sciences which are some of the emerging domains e.g. stem cells, immunohistochemistry and molecular pathology- to name a few. Yet, the book remains connected to the very soul of Forensic Medicine, Traumatology and Toxicology by referring back to prior cited texts and thus avoiding repetition and maintaining chronology stimulating the reader and allowing for both horizontal and vertical integration, which is also the essence of Competency Based Medical Education Curriculum. The text is amply studded with memory aids and some of the handmade diagrams by the Author- one of particular note is memory aid designed for remembering cranial nerves on Page No 18, which makes the anatomical orientation of the various cranial nerves with respect to each other as well as vastly simplifies the topographic anatomy. Not to suffice, the text contains numerous demonstration videos which are a rarity in the existing literature and help the reader in grasping the basic concept e.g. experimental demonstration of the law of Laplace given on page no 51, which helps in conceptual understanding of the abstract terminologies. General Pathology given in Chapter 4 is a welcome inclusion as it helps in understanding the basic pathologic principles which are the basis for understanding and interpreting Forensic Pathology. A clear differentiation between Septicemia, sepsis and septic shock, based on updated scientific criteria is heartening to see on Page no’s 96 and 97. Another exciting feature of the book is the innumerable case studies which make the topics both entertaining to read and further act as reminders how one particular development has a legal bearing or implication. Chapter 6 discusses general pharmacological principles which have importance in the field of clinical and forensic toxicology. Questionnaire towards the end of each topic are though provoking e.g. anti-neoplastic drug for homicide brings one to an old case of murder by means of Lomustine, which is a drug employed for brain tumor treatment but the aplastic anemia and multi-organ failure which are the consequence of it’s overdose resemble natural death. This is significant for even clinicians/ emergency physicians who treat a significant number of accidental drug over-dosages to be mindful of the drug history- both prescriptions as well as Over-the-counter (OTC). The chapter on “Radiology as Applied to Forensic Medicine and Toxicology” is very thoughtfully designed considering the advent of Virtual Autopsy at AIIMS in 2021 by the Government of India after the Virtopsy project under Prof Richard Dirnhofer of the Institute of Forensic Medicine, University of Bern, Switzerland. The radiographs important from the point of view of a forensic practitioner have been given along with comparative diagrammatic representation for simplification purposes. Readers shall be in a better position to interpret the basic postmortem radiographic findings if and when needed. National Board of Examinations (NBE) has been asking one question every year in Paper I of Forensic Medicine DNB Theory Examination based upon biostatistics accounting for 10 marks. The inclusion of statistics as applied to Forensic Medicine and Toxicology in Chapter 8 of the book is a welcome step to strengthen the students with the most essential and desired topics e.g. Null Hypothesis, P-value, Z score, etc. which could be asked. The next chapter on Research Methodology is educative for the thesis going and any researcher to understand the various study designs and how to calculate the sample size for a proposed research study. Types of citations and referencing systems have also been elaborated upon and the various indexing systems have been deliberated upon. This is very much needed for a novice researcher as imprecise understanding of these may create impediments in the growth and advancement of the latter. The last few chapters focus on infrastructural requirements related to setting up of a Museum and Analytical Toxicological Laboratory in the Department of Forensic Medicine and Toxicology. Basic chemistry has been given at the end to simplify the understanding of subtlety and nuances of Forensic Toxicology. Few sample questions have been provided in the appendix which could further be enhanced through the addition of previous year questions from various universities. Tentative thesis/ research topics given in the appendix give important food for thought to the examinees and the research oriented ones. Overall the book is a novel and fresh initiative in an unexplored genre/ theme which will bode well to the lot to whom it is intended to cover- postgraduates in Forensic Medicine & Toxicology and the faculty. - Dr. Varun Modgil He is currently working as Assistant Professor at Dayanand Medical College & Hospital, Ludhiana, Punjab. He was Senior Resident at Postgraduate Medical Education & Research (PGIMER), Chandigarh. He deposed as an expert witness at various courts in Punjab, Haryana and Chandigarh. He has completed his D.N.B. in Forensic Medicine and also published articles in various National & International journals and also delivered guest lectures in National Conferences on Forensic Medicine. He can be contacted at dr_varun_modgil@dmch.edu ,

Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE MARCH 2000 ISSUE THE POISON SLEUTHS DEATH BY RADON -Dr. Anil Aggrawal "Good morning doctor. Oh, my God, what are you doing today? You have the dead body of a middle aged man today. What happened to him? Please tell me.” “Good morning Tarun. The name of this 45 year old man is Ramlal, and he was working in a drug factory. He was living with his invalid wife and a 20 year old son, in his ancestral house for the last so many years. For some months now, he was not feeling well. His friends and relatives were constantly advising him to see some doctor, but he refused to believe he was sick. He died today morning. Normally in such cases, no police enquiry occurs, but this man was a Union leader, and there have been widespread rumors that the management somehow managed slow poisoning in his case. It has been alleged that this was particularly easy for the management to do so, as he was working in a drug factory, and all sorts of harmful drugs were available to the management. The pressure of the workers was so much, that the police had to arrest the top management people. Currently they are in police custody, and can’t meet anyone." "So what do you think doctor?" "Tarun, I have just now conducted a thorough autopsy on him, and I found that he has died because of lung cancer. Now there is no poison except one that can induce lung cancer, and that is the Radon gas." "You mean someone gave him radon gas to kill him? That sounds preposterous." "I will talk about it later. But first some investigations that I did in this case. When I found that his body was unusually radioactive, I visited his house, and was not very surprised to find a great amount of radioactivity in his house too. In fact this is what I had expected." "From where is that radioactivity coming doctor? Did someone from the management lace his house with radon gas?" "Tarun, the radioactivity in all probability is coming from the underground." "From the Underground? I really don't understand that. Now doctor, I feel I must know the radon story from the beginning. Otherwise I won't be able to follow you intelligently. Kindly tell me the radon story from the beginning." "Tarun, Let me tell you about some general facts about Radon first. It is a colorless, odorless, and tasteless gas found in Group 0 of the Periodic Table. It has a density of 9.25 g per cubic decimeter. In fact, it is the heaviest gas known. It is 7.5 times heavier than air and more than 100 times heavier than hydrogen. The gas liquefies at -61.80 C (-800 F) and freezes at -710 C (-960 F). On further cooling, solid radon glows with a soft yellow light that becomes orange-red at the temperature of liquid air (-1950 C [-3190 F]). Natural radon consists of three isotopes. They have the atomic weights of 219, 220 and 222, and thus are written as radon-219, radon-220 and radon-222 respectively. In chemistry the usual practice of writing the atomic weights is on the upper left hand side of the element symbol; thus the three isotopes are often represented as 219Rn, 220Rn and 222Rn. The half life of all three varieties is very short. But among themselves, the shortest half life is that of the variety having least atomic weight, and the longest half life is that of the variety having the maximum atomic weight. Thus the half life of 219Rn is only 3.92 seconds. Half life, as you surely know is the period, in which the original amount of a radioactive material is reduced by half. The half life of 220Rn is slightly more; 51.5 seconds. The longest lived of all is 222Rn, but even this variety has a half life of just 3.823 days. All the three varieties do not occur in nature as such, but are produced as a result of decay of other radioactive materials. 222Rn is produced by the decay of Radium; 220Rn from the decay of Thorium, and 219Rn from the decay of Actinium. In fact their parent elements give them their more popular names. 222Rn, since it is produced from radium, is known as radon. For similar reasons, 220Rn and 219Rn are known as thoron and actinon respectively. Thus when we speak of radon, we usually refer only to the isotope 222Rn. The other varieties, i.e. thoron and actinon, may be referred to as the isotopes of radon. I may tell you that the first isotope of radon to be discovered was thoron, which was discovered in 1899 by the British scientists R.B. Owens and Ernest Rutherford, who noticed that some of the radioactivity of thorium compounds could be blown away with the passage of time. Radon was discovered in 1900 by the German chemist Friedrich E. Dorn. The last isotope of radon to be discovered was actinon which was found in 1904, independently by Friedrich O. Giesel and André-Louis Debierne. Although these three are the naturally occurring isotopes of radon, now more than a dozen artificial radioactive isotopes of radon are known. I may tell you that radon and all its isotopes are rare in nature because they are all short-lived and because their sources, radium, thorium and actinium are rare. The atmosphere contains traces of radon near the ground as a result of seepage from soil and rocks, all of which contain minute quantities of radium. You may ask where the radium comes from within the soil and rocks. Actually Radium occurs as a natural decay product of uranium which is present in various types of rocks. It is now known that some tracts of land contain unusually high amounts of uranium beneath. This gives rise to more radium and more radon, which seeps up through the soil and collects in homes if they happen to be built on that land. Radon is now known to cause lung cancer in populations which are exposed to it. Indeed, radon is now thought to be the single most important cause of lung cancer among nonsmokers. By the late 1980s, naturally occurring radon gas had come to be recognized as a potentially serious health hazard. The gas, arising from soil and rocks, seeps through the foundations, basements, or piping of buildings and can accumulate in the air of houses that are poorly ventilated. Exposure to high concentrations of this radon over the course of many years can greatly increase the risk of developing lung cancer. Radon levels are highest in homes built over geological formations that contain uranium mineral deposits. I may tell you that 222Rn is itself radioactive, and it decays into 218Po, which in turn decays into 214Pb, 214Bi, 214Po. These four radionuclides are called the radon daughters. They all become attached to particles in the air and get breathed into lungs. 222Rn, 218Po, 214Po are all alpha emitters. Radiation can cause damage to biological molecules, and can induce cancers, genetic defects and accelerated aging." "Doctor, all this sounds very frightening indeed. You told me that by the late 1980s, radon had come to be recognized as a serious health hazard. Tell me how exactly scientists discovered that radon gas could be emanating from the soil and collecting in the houses." "Tarun, it is a very remarkable story indeed. It started on December 2, 1984, in Pennsylvania, USA. Before that it was known that radon occurs as a serious health hazard in mines, but its occurrence in ordinary homes was not known. During December 1984, the alarm bells in the Limerick nuclear power plant (in Pennsylvania, near Philadelphia, USA) were constantly ringing, indicating that someone had been contaminated with radioactivity. But it was not known who it was. There were concerns that the radioactivity might escape and pollute the environment. Then on the fateful day of 2 December 1984, a worker Stanley Watras was found to be unusually radioactive. When more investigations were done, it was surprisingly discovered that the radioactivity was coming from his house. Some people believed that he was stealing some radioactive material from the work place and taking it home, but none was found. Still more investigations showed that unusual amounts of radon were leaking in his house from the underground. The house of Watras was so radioactive that the health risk of living there was the same as smoking hundreds of cigarettes a day! On detailed investigations it was found, that his house straddled a vein of uranium ore. The authorities decided to investigate the levels of radon in other nearby houses and the results were worrying. By the end of 1986, about 20,000 houses had been checked in Pennsylvania, and one in eight were found to be overloaded with radon! Well, here in the table you can find some important dates in radon research in America. (N.B. The table is quite complex and is very difficult to put over the net. Readers desirous of having the table may want to get in touch with the webmaster.) "Oh, that is quite informative." "Gradually, the public became so concerned about radon, that the government found it imperative to decide upon a safe level of radon, which could be allowed in the homes and at workplaces. These levels were called Action Levels. Levels above these Action Levels were considered unsafe and legislations were passed, which could prosecute managements if they allowed radon levels to rise above these prescribed limits. Action Levels for homes were 200 Becquerels per cubic meters (200 Bq m-3), while those for work places were 400 Becquerels per cubic meters (400 Bq m-3).” “Sorry to interrupt you doctor, but I don’t quite understand the concept of Becquerels. Could you please explain me that?” “Sure. Antoine Henri Becquerel, as you surely know was a French physicist who discovered radioactivity through his investigations of uranium and other substances. In 1903 he shared the Nobel Prize for Physics with Pierre and Marie Curie. In his honor, scientists have named the unit of radioactivity. A sample of radioactive substance would be said to have a radioactivity of one Becquerel if in that sample one atom disintegrates per second. So if I say that the level of Radon in a particular home is 200 Becquerels per cubic meters, it means that there is so much Radon in that house that in every cubic meter of that house, 200 atoms of Radon are disintegrating per second. This is a very small Unit. A bigger Unit is Curie, which is equivalent to 3.7 X 1010 Becquerels. You might be surprised at this odd figure. Actually one Curie is the amount of radioactivity given off by one gram of radium. And it is seen that in one gram of radium, about 3.7 X 1010 atoms disintegrate per second. Hence this figure. You might think that the unit Curie is named after Marie Curie, the joint winner of Nobel Prize with Becquerel, but it is actually named after her husband Pierre Curie, who too shared the Prize with them. This is a little known interesting fact. Most people wrongly think that this unit is named after Marie Curie. While I am on the subject, I may tell you something more about the safe levels of Radon in houses. It was found that houses with levels of 2000 Bq m-3 and more were very dangerous places to live in. The house of Stanley Watras had fifty time more radioactivity than this - a radioactivity of 100,000 Bq m-3!” "Doctor, now I know enough about Radon and its dangers. Do you seriously think, someone from the management arranged for the radon gas to be accumulated in Ramlal's house so he could die of lung cancer?" "Tarun, theoretically speaking it is possible, but practically such a possibility is exceedingly low. Radon is not an easy gas to prepare. Concentrated samples of radon are prepared synthetically for medical and research purposes only and that too in highly specialized labs. Typically a supply of radium is kept in a glass vessel in aqueous solution or in the form of a porous solid from which the radon can readily flow. At intervals of a few days, the accumulated radon is pumped off, purified, and compressed into a small tube, which is then sealed and removed. The tube of gas is a source of penetrating gamma radiation, which comes mainly from one of radon's decay products, bismuth-214 (214Bi). Such tubes of radon have been used for radiotherapy and radiography. My initial thought was that Ramlal's house is built on a tract of land which is rich in Uranium, but I had to get the opinion of a geologist before I could finally say anything. I have got that opinion now, and the report says that my guess was correct. Ramlal’s house indeed is constructed over a land rich in Uranium. Come let us tell the police that those management people are innocent, and it was Radon, which took the life of Ramlal. "Unbelievable! This was a most interesting discussion doctor. Tell me what are you going to tell me the next time?" "Tarun, next time, I would tell you about a very interesting poison - Hydrogen Peroxide."

Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE JANUARY 1999 ISSUE THE POISON SLEUTHS DEATH BY SODIUM NITRITE -Dr. Anil Aggrawal "Good morning doctor. Oh, my God, what are you doing today? You have the dead body of a young woman today. Her whole body seems to have a chocolate brown color. I remember last time too, I had seen a dead body with chocolate brown color. Did this woman also die of the same poison? Please tell me." "Good morning Tarun. The name of this young woman is Radhika, and she is about 25 years old. She died in her flat at about 9 am today morning. She was a junior executive in a private firm here in Delhi, and was living alone in this flat. Her family members are living in Jaipur. She was living here solely for the purpose of this job. Her parents were looking out for a match for her marriage." "Oh, I see." "Yesterday night she was fine. In fact, she met one of her neighbors Shyamala -also a 25 year old girl- at about 9pm, and she tells us that she was perfectly in good spirits. That rules out suicide...." "Wait a minute doctor. If a person is in good spirits and cheerful a day before his or her death, does it rule out suicide? Is it not possible that she was trying to mislead the neighbors by being cheerful so that nobody gets to know her intentions?" "There are other indications too. There is no suicide note. Generally a person who commits a suicide, leaves a suicide note." "Oh, I see" "Well, the police interrogated Shyamala more about her as she was the only one, who knew Radhika very well. She told the police that she (Radhika) was in love with Chaman, a 26 year old colleague in her office. Recently she had become pregnant by him, and she was pressing him for marriage. However Chaman had lost interest in her, and was trying to avoid her. Only 2 days back she had threatened him to go to his parents if he did not agree for the marriage. Chaman's parents are very religious and God-fearing, and he knew if she approached them, they would force him to marry her. To settle matters he came yesterday to Radhika's flat at about 7 pm. Shyamala knows because when he came, Radhika called her as a mediator. Shyamala tells the police that Chaman was looking very tense and jittery. She thought it was because he had such a difficult matter to resolve. Anyway she just sat there for about an hour. When she saw that the matter is going to take more time, she left the house making an excuse. When she left, Radhika was just preparing to go inside the kitchen to make tea for everyone. She offered Shyamala to go after having tea, but she just left. She however saw Chaman leaving Radhika's house only about 15-20 minutes later. She was sitting idly at her window when she saw him. He looked to be in great hurry." "Oh, I see. So did you find anything in the post-mortem that corroborates what Shyamala is saying?" "Yes, I found a 4 month old male baby inside Radhika's uterus, which definitely tells us that she was pregnant. I have kept the tissues of this fetus for his DNA profiling, which will tell us definitely if Chaman was his father or not. More about that later. What interested me was the color of her body. I told you last time (See SR December 1998 issue) that there are certain poisons which can cause methemoglobin to form inside the body. It is this compound which imparts such color to the body. Well one of such poisons is sodium nitrite. I got a hint that she might have died of sodium nitrite poisoning when I went to her flat and saw that she had unfinished breakfast on her table. She was in the habit of having a full meal in the morning itself. She had prepared Dal and Roti and must be eating it. And it was lying there unfinished. Nearby I could see some dried vomitus on the floor. Obviously when she was eating the food, she must have got sick and must have vomited. I saw a salt cellar on her table which was open. I got quite curious, when I glanced underneath the dining table and found lot of white salt like powder spilled over there. As a poison sleuth, I don't want to take chances and intuition told me there was something either in the salt cellar or in the powder spilled over the floor that we were looking for. So I quietly kept the salt cellar in my pocket and also some of the powder spilled over the floor underneath the dining table. I examined both these substances in my lab. And do you know what I found?" "What? Please tell me doctor. I am getting curious." "Tarun, I had the most extraordinary finding in the salt cellar. It had a substance looking like salt but it was not sodium chloride. It was sodium nitrite. And the salt like powder which was spilled underneath the table was nothing but sodium chloride. Do you get the picture now?" "Well, not really. I don't understand how such a curious thing happened." "To me it is clear like glass. Obviously someone replaced the salt in the cellar with sodium nitrite. And before doing this he spilled the salt underneath the table to empty the cellar so he could fill it with the poison he had brought with him. The only commonly available poison which looks and tastes like salt is sodium nitrite" "Really? Doctor I am getting curious. Please tell me more about sodium nitrite." "Tarun, as I told you earlier, sodium nitrite causes methaemoglobinaemia; even small doses of sodium nitrite can kill within a few minutes. Even the nitrates can be dangerous. Organic nitrates in fact are reduced to nitrites in the intestine. Inorganic nitrates, bismuth subnitrate excepted, are not normally reduced to nitrites in the body, but this may occur when the upper digestive tract (stomach and upper part of small intestines) is infected with nitrate-reducing bacteria, e.g. Escherichia coli. Inorganic nitrates are irritants of the stomach and, in large doses, potassium nitrate is a diuretic. A diuretic is a chemical which increases the production of urine. Poisoning by nitrites is actually not very common. It can result from mistaking this salt for common salt or Epsom salts." "Doctor, under what circumstances can sodium nitrite poisoning occur?" "Tarun, poisoning can be homicidal, accidental or suicidal. With sodium nitrite, accidental poisoning is probably most common, although homicidal poisoning is also possible as we have seen in the case of Radhika. One of the earliest reports of sodium nitrite poisoning came from Middlesborough, UK in 1936. Two adults and their daughter aged five were suddenly taken ill after the midday meal. The adults died before a doctor could reach them and their daughter died shortly after her admission to hospital. It appears they had complained to neighbors of acute abdominal pain and vomiting. Their faces went blue. Investigation showed very similar results to what I found in Radhika's case. A basin of cooking salt and a salt cellar contained sodium nitrite; the upper layer in the latter was of 98% sodium nitrite and the lower layer 98.2% common salt. Unconsumed food contained sodium nitrite, e.g. cabbage 6.5% and Yorkshire pudding 4.5%. The gastric contents of the man contained 4.275 g and those of the woman contained 1.284g of sodium nitrite. Over a gram of the poison was present in the child's vomit. The vomit of the adults was not available for analysis, but presumably they had ingested considerably more than remained in their stomachs. The source of the poison was not determined, but the man had had access to sodium nitrite in the course of his employment. Nobody knows how the mix up happened. Probably someone filled up a half empty salt cellar either intentionally or mistakenly with sodium nitrite." "Oh, that is most extraordinary and bears an eerie resemblance to the case we have on our hands." "Yeah sure. Accidental deaths due to the ingestion of sodium nitrite used in error for common salt in the preparation of soup have also occurred. Several such accidental deaths have been reported. Death in these cases occurred within a few minutes following symptoms which included nausea, headache, vertigo, urgent vomiting, profuse diarrhoea and cyanosis (bluing of the skin). Stomach contents in most of these cases contained sodium nitrite ranging from 1.74 to 84.0 mg/kg of the gastric contents. There was a more consistent concentration in the organs, e.g. in the liver, where the concentration was between 3.0 and 4.35 mg/kg. A quarter of a litre of the soup in most of these cases contained l.5 g of sodium nitrite. I must tell you that the fatal dose of sodium nitrite is from 1 to 2 g. I have already explained you the concept of fatal dose (see "Poisoning by Thallium" SR, October 1997)." "Yes doctor, I do remember you having mentioned it." "In another case, eleven men were poisoned after eating oatmeal seasoned with sodium nitrite in mistake for common salt. The men added more salt from salt shakers later shown to contain sodium nitrite. Immediately after the meal they felt sick and vomited. There was dizziness and abdominal cramps. They went blue and five lost consciousness. Methaemoglobin was later demonstrated in their blood. One of these men, aged 82, died the next morning; his organs had a diffuse brown colour. The source of the poison was nitrite used to cure meat. Only eleven of 125 persons who ate of the oatmeal were affected and these eleven had used contaminated salt shakers of which one contained 0.137% of nitrite. It was estimated they had taken at least 163 mg. In yet another case, a boy aged two months suddenly went blue, 'almost black', after his 7.0 am feed. Sodium citrate had been prescribed for the relief of indigestion and two tablets had been added to the feed. When seen in hospital, about five hours later, the appearance of the child simulated those of congenital heart disease; he was neither distressed nor febrile. A diagnosis of toxic methaemoglobinaemia was made and the remaining tablets, fortunately available, were subjected to analysis. They proved to contain 65 mg of sodium nitrite each. The infant, therefore, had ingested 130mg, the maximum dose for an adult. There are a host of other such cases of which I am aware." "Doctor please tell me a few interesting ones out of these." "In one case, two children aged two and three months respectively took feeds to which from 35 to 40g of sodium nitrite had been added in error for sodium citrate. The elder infant died. Cyanosis and blackening of the mouth were outstanding features. In another case, a boy aged two years vomited while playing with his elder brother aged nine. After a second vomit he was given a glass of water to drink. Vomiting continued and he was taken to hospital. He was deeply cyanosed, collapsed and crying with spasms of pain. Poison was taken out from the stomach with the help of a tube and oxygen was administered, but the child died at about three hours after being poisoned. Sodium nitrite was detected by analysis of his stomach contents. There was methaemoglobin in the blood. It is probable that the boy had ingested and absorbed appreciably more of the poison. The source of the poison in this case was a bottle of sodium nitrite, now nearly empty, which the elder boy had brought for the purposes of a chemical experiment. The dead child had licked the bottle. I must tell you that sodium nitrite is highly soluble in water and its taste resembles that of common salt and that is what makes it such an attractive homicidal poison. Interestingly sodium nitrite is used in machine oil also as a corrosion inhibitor, and deaths have occurred when someone accidentally drank machine oil. There is a case of a girl on record who died in this way. She was eleven years old, and drank a mouthful of machine oil accidentally, some of which she immediately spat out...." "Just a minute doctor. I think sodium nitrite is an oxidizing agent, and if I remember my chemistry alright, corrosion is an oxidative process. Then how can nitrite be used as a corrosion inhibitor?" "Tarun, sometimes oxidizers are also reducing agents. Such is the case of nitrite, which can be further oxidized to nitrate. I must tell you that the tendency of nitrite to act as an oxidizer is increased in an acid environment such as that found in the stomach. At higher pH levels its oxidizing potential is greatly decreased. Corrosion can be inhibited by using a sacrificial reducing agent such as nitrite. Sodium nitrite is also commonly put into packaged foods like meat to keep oxidation from happening. So I was telling you about that little girl. Within an hour she was unconscious and deeply cyanosed. Fortunately she recovered after proper treatment. Analysis showed that the oil contained 36.5% sodium nitrite, 7.5% of an emulsifying agent and 56.0% water. Her stomach washings contained 7-8mg/ 100 ml of sodium nitrite." "Oh, that is certainly most extraordinary!" "Tarun, sodium nitrite poisoning has happened in other ways too. Poisoning by well water drawn from badly constructed wells near farmyards may contain an appreciable amount of nitrate which makes it unfit for drinking and a source of poisoning newborn infants. This illness is however rarely fatal. About 30 cases are on record and only one, it appears, was fatal. It is apparent that the risk is only to infants of under 90 days old, who live in rural communities..." "Doctor, can boiling the water make such water safe? I have heard that boiling the water makes it cleaner." "Yes boiling the water does make it free of infective micro-organisms, because they get killed by boiling, but when the water is contaminated with a chemical substance, it gives no protection whatsoever. On the contrary, it concentrates the nitrates, which can get concentrated upto 3 times on boiling the water! Older children are unaffected, probably because they can tolerate the amount of nitrate likely to be present in their normal fluid intake. It does appear that poisoning in these circumstances is not dependent only upon the amount of nitrate ingested· It has been suggested that poisoning by nitrate will only occur in those whose gastric juice exceeds pH 4.0 and when nitrate-reducing bacteria are present in the upper digestive tract." "Doctor, this is a most extraordinary fact that you have told me. Can you tell me what is the concentration of nitrites in such contaminated water coming from wells?" "The contaminated water, usually drawn from shallow wells, of not over 75 feet deep, usually contains over 20 ppm (parts per million) of NaN03. Methaemoglobinaemia (the existence of too much methemoglobin in the blood) does not normally occur unless the water contains 30 ppm. The upper limit of nitrate should not exceed 10 ppm because as I told you earlier, if boiled the water could be concentrated threefold and thus to a dangerous concentration. Even cows which feed on beet tops rich in nitrates develop methaemoglobinaemia. This is known as the condition of 'purple' cows and is well recognized. Purple is the color the cows get when there is lot of methemoglobin in their blood." "Oh, this is most extraordinary." "There are more interesting facts Tarun. Nitrite poisoning from spinach has also occurred. During 1959-65 in Germany there were 15 cases of nitrite poisoning in infants, aged two to ten months, who had eaten spinach. Nitrite and the remains of spinach were found in the stomach contents of one of the infants. Two factors were responsible. First, the excessive use of nitrate fertilizer, which should not, but often did, exceed 80 kg/hectare. Second, bacterial activity converted the nitrate in spinach into nitrite. Samples of spinach, fresh, frozen and tinned, showed a nitrate contamination of from 40 to 2100 mg/kg. The risk arose when the feed was prepared in advance and stored overlong at room temperature. Even after cooking, a sufficient number of bacteria remained to produce nitrite. The maximum nitrate content of spinach should not exceed 200mg/kg. It has even been recommended that during the first three months infants should not be given spinach." "Doctor, such an interesting poison must have caught the fancy of suicides also. Have there been cases of suicidal poisoning too with sodium nitrite?" "Yes, sure. Suicidal poisoning with sodium nitrite has also occurred. A medical practitioner, aged 51, committed suicide in 1942 by ingesting sodium nitrite. He had been mentally ill for some time. On the night of his death he awoke his son, a medical student, and told him that his mother had suddenly been taken ill during the night. A doctor was summoned and while he was attending to the woman a bump was heard in the passage. The deceased was then found lying on the floor; he died within five minutes of his fall. Poisoning was suspected, but a search revealed only a glass of brandy and another which appeared to contain water. Toxicological analysis demonstrated 2g of sodium nitrite in the gastric contents. The blood was 'dark'. Unfortunately no analysis was made of the brandy or water, otherwise I am sure they would have found nitrite in the brandy. The deceased had given his wife some of the brandy during the night and this may have been the vehicle of poison responsible both for her illness and his death. I feel he first gave brandy laced with nitrite to his wife and then consumed the poison himself, but of course it is only a guess. But sure enough, it is possible to kill someone by lacing his or her drink with as little as 2 grams of sodium nitrite. It was believed that the poison was taken within an hour prior to his death. It was suggested by the relatives that he had died of a heart attack, but the doctor said that he had died of nitrite poisoning." "Oh, doctor. We could go on and on with such interesting stories. Tell me how you can prove Radhika died of nitrite poisoning?" "Tarun, I told you I examined both the contents of the salt cellar as well as the powder spilled over the floor. Now I will tell you what happened. Chaman came to Radhika's house not for reconciliation, but for killing her. He was sure, killing her was his only way out. He got sodium nitrite from a chemistry lab. We have still to find out, how he got hold of it, and who gave it to him. He came fully armed with this poison in a packet. When Shyamala left and Radhika went inside the kitchen to make a cup of tea, he quickly picked up the salt cellar, spilled the salt in it on the floor underneath the table and refilled it with the powder that he had brought. He knew that sometime she would consume the contents of the salt cellar thinking it was salt and she would die. It was no doubt a very clever plan, but thankfully we could catch it. The color of Radhika's body at once told me we were looking for a poison which produces methemoglobinemia, and that was Chaman's undoing. I have found an appreciable quantity of Sodium nitrite from Radhika's stomach contents, and to top it all, the police has found some left over sodium nitrite from Chaman's house too. Initially he denied having any hand in Radhika's death, but when he was told of all the medical and circumstantial evidence against him, he broke down and admitted his guilt." "Very clever doctor. This was a most interesting discussion doctor. Without your masterly deduction, Chaman could never have been caught. People might have thought, it was an accidental death. Tell me what are you going to tell me the next time?" "Tarun, next time, I would tell you about a very interesting poison. You may not have even thought that it was a poison. I will tell you about death by Potassium Permanganate."

| Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology Call For Reviewers Become a reviewer for Interacting with Anil Aggrawal’s Internet Journal of Forensic Medicine and Toxicology . * This journal receives a large number of manuscripts and other material for publication as original papers/review papers/high resolution pictures for poster presentation/UG material/PG material and contributions for a number of other sections. * To be able to deal with large amount of unprocessed material, we are currently diversifying our reviewer pool. Younger scientists are encouraged specially, so they can be involved in paper publication process. * Interested in reviewing or have questions? Email the editorial office by clicking here . What is peer review ? Peer review is not only the foundation, but a very strong pillar of scientific publishing. It is an honest assessment of a piece of writing by a “peer”, a person who understands and practices the same science. When you are asked to review a manuscript that has been submitted for publication, you are helping the journal to “weed out” unsuitable material, and select what should be included in a well-respected journal. Not only this, simultaneously, your expertise is being acknowledged and your opinion is being valued. Our reviewers – by accepting only high quality original papers – help us to publish only the highest quality research and reviews. Who can become a reviewer? If you are active in the field of forensics/criminology/law and related sciences and can objectively evaluate the quality and rigor of research, we want you! Send us your latest CV attached with your high resolution photograph. We are looking for peer reviewers with following qualities: • Should have sound academic credentials • Should be active in the field of forensics; new research paradigm: interaction process and methodology • Should provide constructive criticism to authors. Benefits of reviewing for this journal Becoming involved in the peer review process for this journal can be a highly rewarding experience for the following reasons: • Reviewers are recognized on an annual basis in the journal; Please Click here to see how reviewers are acknowledged. • If you are interested in joining the editorial board , you would be able to do so, after you have completed 100 peer reviews. • You can get academic credit for your peer review by signing in your Web of Science/Clarivate/ORCID Academic profile. Please click here to sign in or register • You get complimentary access to academic material [papers/books etc needed to consult for reviewing etc.]. You need to send us PMID of the paper required. • You get a reviewers’ certificate after completing 25 reviews. Click here for an example. The peer review process Remember that authors are our friends. Our aim is to improve their manuscripts. If grammar/spellings etc. are wrong, they may be advised to get it corrected through someone who is a native English speaker, or better still with a teacher of English language. The manuscripts are checked especially for originality. We have a zero tolerance for plagiarism. Thus all manuscripts must be checked through an authentic antiplagiarism software [e.g., iThenticate ]. References must always be checked, ensuring specially that they are all in uniform style [Vancouver style]. Manuscripts are always sent to two [in rare cases more also] independent reviewers. Based on the feedback from these reviewers and the editors' judgment, a decision is given on the manuscript.

| Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology Contributing Partners Gyan Fernando Gyan Fernando, MB, BS, MD, FRCPath, DMJHome Office Pathologist Devon & Cornwall UK E-mail Dr. Fernando Dr. Gyan Fernando was born in Colombo, Sri Lanka (then Ceylon) in 1949. His early education was in a Catholic school and in 1968 he entered the Faculty of Medicine, University of Ceylon, Colombo. Extra curricular activities, notably editing the student "rag" was more important to him than studies. This led to failing Anatomy and Biochemistry. He never failed another examination. However, he considers the five years spent in medical school to have been the best years of his life. In 1973, to the relief of his parents, he qualified as a doctor. Soon afterwards he got married to Ranji, a fellow medical student. He is still married to her. Because of living well away from their parents, the marriage survived the first few crucial years and a son was born in 1976. After a short spell in general medical and obstetric jobs he opted for Forensic Medicine purely because no one wanted the forensic job in a remote but beautiful part of the country where he wanted to live. In 1978 he moved to Britain where he soon discovered that training in Forensic Medicine did not exist. Wisely he decided on Histopathology and in 1984 obtained Membership of the Royal College of Pathologist by examination. (Later, "having furthered the interests of the College" without getting into trouble, he was made a Fellow.) In 1985 he obtained the Diploma in Medical Jurisprudence and was appointed the Senior Forensic Pathologist to the University of Dundee and very soon took over as caretaker head of department. In 1989 he was appointed Senior Lecturer in Forensic Medicine, University of Edinburgh. At present he is the Home Office appointed Consultant Forensic Pathologist for Devon and Cornwall in which post he has been in since 1993. As a firm believer that "autopsy" means "seeing for oneself" and not gathering knowledge from books, he has always been a hands-on pathologist and has very little respect for academics. Another of his pet dislikes is bureaucracy. Over the years he has surrounded himself with books mostly of humorous and satirical writing, favourite authors being P.G.Woodhouse and James Thurber. He also has a fondness for cartoons. Since his school days he has been interested in railways and combines holiday travel with study of railways. Ramesh Kaul Ramesh Kaul, MD., MS., FCCP USA E-mail Dr. Kaul Dr. Ramesh Kaul was born and brought up in India, where he qualified in medicine and surgery from the prestigious All India Institute of Medical Sciences. Later he obtained his post-doctoral qualification in otorhinolaryngology from the same institute. A man of many interests and tastes, he is widely known among his peers as the modern Leonardo da Vinci. He is Board Certified in Pulmonary Medicine, and is currently working as a pulmonologist in the US. His several fields of interest include investigations into metabotropic receptors. He runs his own sites on lung cancer. Among his best known and widely respected sites are www.thorax.us and www.lungcancercare.com and www.rameshkaul.com . He lives in Pittsburgh and New Castle.

Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE JULY 2000 ISSUE THE POISON SLEUTHS DEATH BY POTASSIUM BROMATE -Dr. Anil Aggrawal "Good morning doctor. Oh, my God, what are you doing today? You have the dead body of a young child today. What happened to him? Please tell me.” “Good morning Tarun. The name of this young child is Nitya, and he is four years old. He was the only son of his parents. Till yesterday evening he was alright. He was playing in front of his house quite cheerfully. After sometime, he started vomiting and felt very restless. His parents noted that he vomited some blood too. They became very afraid, and took the child immediately to the doctors. The doctors took it to be a case of gastroenteritis and started treating him along those lines. However the child failed to show any improvement and died today morning. Now the police has brought his body to me. My job of course is to tell them, how Nitya has died.” “But surely Nitya has died due to some natural disease. We don’t really need a post-mortem in this case, do we?” “Tarun, the doctors at the hospital where he was being treated have refused to give any cause of death. They say, that they just did not have the time to diagnose his disease. For all we know this could very well be a case of poisoning too.” “Really? Have the parents of Nitya given some hint in this direction?” “Police has made some enquiries and have come up with some interesting results. Ramlal, the father of Nitya was not going along well with his neighbor Raghav. Both Ramlal and Raghav claimed a hundred square yard plot somewhere in Ghaziabad. A court case was also dragging on in this connection for quite sometime. Recently there had been indications that Ramlal would ultimately win the case. Raghav had become very restless after that. He had sworn several times before neighbors that he would teach a good lesson to Ramlal. It is quite probable that Raghav gave some kind of poison to Nitya to get even with Ramlal.” “What do you think Doctor?” “Tarun, the first thing I did was to ask the police what Raghav does. They told me that he works at a modern hair saloon called “Hairwaves”. Now “Hairwaves” is really a very modern and posh hair saloon offering all kinds of hair treatments to their customers. The moment I heard this, I immediately became attentive, because a chemical potassium bromate usually found at hair saloons usually produces the kind of symptoms Nitya showed. Come to think of it, I think Nitya in fact has been poisoned by Potassium Bromate.” “But doctor how can you be so sure?” “Potassium bromate seems the most likely candidate Tarun. Now let me tell you that in Japan, in the 1960s and 1970s there were about 20 cases of suicides by hair dressers. And do you know which chemical they used for self-poisoning? All of them used potassium bromate, because this is so easily available to hair dressers.” “Doctor, it looks like we are on to one of your great stories. Why don’t you tell me about potassium bromate from the beginning?” “Tarun, the chemical formula of potassium bromate is KBrO3. Both Potassium and sodium bromate (NaBrO3) have no medicinal use. They are used solely as flour bleaches and as “neutralizers” in cold wave hair permanent kits, which can contain either 2% potassium bromate or 10% sodium bromate.......” “Sorry to interrupt you doctor, but what are flour bleaches and how are they used?” “Tarun, flour that we get from wheat has to be “treated” with the use of “improvers”. These “improvers” are nothing but oxidizing substances which enhance the baking quality of flour, allowing production of better and larger loaves. Relatively small amounts of these “improvers” are required, generally a few parts per million. Similarly to reduce the yellowness of the flour, bleaching agents may also be required. Although such improvers and the bleaching agents used to rectify excessive yellowness in flour are permitted in most countries, the processes are not universal. Improvers include bromates, chlorine dioxide (in gaseous form), and azodicarbonamide. The most popular bleacher used is benzoyl peroxide. But in many places potassium bromate is still used.” “Oh, I see. You used another word ‘neutralizers’. What are these?” “Tarun, there was a time when making the hairs wavy had become a fashion. In the late 1940s and during whole of 50s, it was fashionable to make the hair wavy. To do this, the hair was first treated with a milky waving lotion, the active ingredient of which was ammonium thioglycollate. At the appropriate time its effects were arrested by applying a neutralizer, i.e. a solution of potassium bromate, prepared from a small packet of the crystals. Outfits for permanent waving of hair by a cold process in the home became available in the UK round about 1950 and a little earlier in the United States. In the US in the late 1940s and early 1950s, home kits for making hair wavy were easily available, resulting in several cases of bromate poisonings, primarily in children under the age of 4. As I told you earlier, in Japan several cases were reported where hair dressers had apparently taken potassium bromate as a suicidal agent.” “Oh, that is most interesting. So this chemical is so dangerous that it can kill too?” “Yeah, and what makes it still more dangerous is that it is colourless, odourless and tasteless too, thus making it a very good candidate as a homicidal poison. A substance which is colourless, odourless and tasteless can be very easily administered to a victim mixed in his food, without him knowing anything about it. For the same reason, it can be taken by mistake too, especially if left in a cup or milk bottle. Cases have been reported in medical literature about the death of children who have ingested hair neutralizer accidentally. Many toxicologists in fact have talked about the possible danger of the ‘home perm’ outfits.” “Doctor, what are the other circumstances in which potassium bromate may be ingested by a human being?” “The majority of cases of poisoning are of course the result of accidents. A case has been described in the medical literature of the accidental poisoning of four adults who drank coffee prepared with fluid which proved to be hair neutralizer placed in an empty milk bottle. Except that they had thought the coffee tasted salty they were unaware of its nature until, half an hour later, they were seized with abdominal cramps and vomiting and, at the end of an hour, abdominal pain of a griping nature and diarrhoea. Fortunately all four made a complete recovery at the end of 24 hours. Hair neutralizer was administered by a woman to members of her family, apparently to enable her to enjoy the company of another man. She put some in her husband’s tea, and in orange squash which she gave to her daughters. The husband had abdominal pain which was ascribed to dysentery contracted while absent on military service. When the others became ill, the doctor suspected poisoning. The woman was later convicted of administering poison with intent to injure and was sentenced to 18 months imprisonment.” “Oh, that is quite interesting. What are the symptoms after ingesting this poison?” “Tarun, this compound is absorbed almost unchanged in the gastrointestinal tract. A very slow reduction of bromate to bromide may occur in the body, which can minimally elevate bromide levels in the blood. Potassium bromate causes gastrointestinal irritation and kidney damage as its principal effects and there may be incidental damage to the liver. Unlike potassium chlorate, however, potassium bromate does not break RBCs, a process known as haemolysis. The gastrointestinal symptoms are non-specific. Within half an hour the patient has nausea and vomits and this may be accompanied by epigastric cramps. Vomiting is repeated and may continue for a few days. There may be blood in the vomit. Within about an hour there is abdominal colic and diarrhoea. Some toxicologists think that the stomach and intestinal complaints are due to the caustic hydrobromic acid produced when bromate reacts with gastric juice. I may tell you that in Potassium chlorate poisoning, a special compound is formed in the blood. This is known as methemoglobin, and is chocolate brown in color. This feature has not been detected in humans with bromate poisoning. Fall in blood pressure may or may not occur. Severe poisoning leads to damage of kidneys and in consequence there is decrease in the formation of urine, coming to a complete halt after some time. This causes a rise in the blood urea concentration. In some cases generalized seizures are seen. It has been estimated that the fatal dose of potassium bromate is about 240-500 mg/Kg. If 300 mg/Kg is taken as the average fatal dose, then about 18 g would be required to kill a 60 kg man. The weight of Nitya is about 14 kg. So only about 4-5 g of potassium bromate must have been needed in this case. If you look under the microscope you would find that the kidneys of Nitya are damaged. Technically this change is known as renal tubular necrosis. Similarly I am also finding damage to his liver and heart, both of which are seen in potassium bromate poisoning. I have also recovered potassium bromate from Nitya’s stomach and have chemically identified it. There seems little doubt now that he was poisoned. And Raghav is indeed the poisoner. It was only he who had access to this dangerous chemical. He must have been taught during the course of his profession that this is a dangerous chemical. He somehow was able to smuggle some amount of Potassium bromate from his work place to his home. When Nitya was playing in the evening, he must have approached him with some kind of drink, may be a sherbet, in which he must have mixed potassium bromate. He wanted to kill Nitya, which was his way of getting even with Ramlal. Come let us tell the police who the culprit is. They will search his house, and if any of the remaining chemical is found in his house, everything would become very clear.” “That is very clever of you doctor. Without your clever deduction it would have been impossible to say how Nitya died and Raghav may have gone scot-free. What are you going to tell me next time?” “Tarun, next time, I would tell you about a very interesting poison - Ethylene Glycol."

Reviewers' Board: Best Toxicology Books A journal affiliated to Anil Aggrawal's Forensic Toxicology Page V.V.Pillay, MD, DCL Professor, Dept. of Forensic Medicine & Toxicology Chief, Poison Control & DNA Typing Units, Amrita Institute of Medical Sciences & Research, Cochin 682026 South India E-mail: toxicology@medical.amrita.edu Professor V.V.Pillay has been in the vanguard of the movement among medical professionals in India to develop the neglected field of Toxicology. He has published extensively in both the scientific and lay press on matters relating to Toxicology, as well as his chosen discipline - Forensic Medicine. Dr.Pillay has authored 5 books on Forensic Medicine and Toxicology, and has received an award for one of them (Modern Medical Toxicology), generally considered to be a trend setter among books on the subject in India. He has reviewed several books on Toxicology for the Internet Journal of Forensic Medicine and Toxicology. Dr.Pillay received a scroll of honour in appreciation of work done in the field of Toxicology from the Medicolegal Society, All India Institute of Medical Sciences, New Delhi. He is instrumental in establishing a state-of-the-art Poison Control Center at the institute where he is currently employed, which is among the few such Centers in India recognized by the World Health Organization. Among his most sought-after publications is a 700 page reference work on Toxicology. Dr. Pillay has recently started a professional organization exclusively dedicated to toxicology - The Indian Society of Toxicology, which has drawn membership of professionals and researchers from all over the country and abroad. The Society brings out a peer reviewed journal biannually (Journal of Indian Society of Toxicology). Professor Pillay is also an Executive Editor in Anil Aggrawal's Internet Journal of Book Reviews.

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< Back To Main Page. [Epub ahead] Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology Volume 27, Number 1, January - June 2026 Contents Papers Posttraumatic Ischemic Brain Stroke After Sharp Neck Injury: A Case Report Based on Autopsy By: Ivan Tsranchev ¹ , Pavel Timonov ² , Stela Yancheva ³ , Kristina Hadzhieva ⁴ , Teodora Gudelova ⁵ , Mirena Sotirova ⁶ , Antoaneta Fasova ⁷ , Elizabet Dzhambazova ⁸ , Petar Uchikov ⁹ Read Ivan Tsranchev

Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE JULY 1998 ISSUE THE POISON SLEUTHS DEATH BY DNOC -Dr. Anil Aggrawal "Good morning doctor. Oh, my God, what are you doing today? You have the dead body of a young girl today. What happened to her? Please tell me." "Good morning Tarun. The name of this young girl is Seema, and she died this morning in the hospital. Yesterday night she had some severe problem for which her neighbors had taken her to a hospital, but there she died soon after. Well, let me tell you everything from the beginning. She is 24 years old and used to live alone. She is originally from UP, where her parents and family is still residing. She was doing a job in Delhi as a typist, and so was living here for about 2 years. She apparently had a love-affair with one of her colleagues Ramesh. They had a good relation for quite some time, and there were rumours that they were even going to marry." "Oh, I see. But how did she die?" "About a month back, Ramesh's parents fixed his marriage somewhere else, to which Ramesh also did not object much, which in effect meant, that he had tacitly consented for the marriage. When Seema came to know about it, she became mad, and there was a verbal duel between the two. Quite coincidentally, this happened in their office, and everyone saw them fighting them in this manner. That's how we know about this incident." "What was she saying during the verbal duel?" "The colleagues who were present there told the police, that the verbal duel suddenly started and went on for about 15 minutes, till their colleagues intervened. She was saying that Ramesh had shown utter meanness and had deserted her because of her looks. As you can see, she is quite fat. I have measured her height and weight. She is 157 cm in height and her weight is 76 Kg, which as you can see is quite much for her height. Apparently there were sexual relations between the two also, and she was heard saying that Ramesh used their friendship for his advantage, and is now deserting her. He never intended to marry her in the first place." "Is this accusation correct?" "Well, nobody knows for sure. But from what I hear from the office colleagues, Seema was not a very attractive girl, and no male was much interested in her, except for official relations. If Ramesh started nurturing relations with her, it's quite possible, that he was looking for some free fun. Once he had his fun, he decided to marry elsewhere." "Are you hinting that he killed Seema?" "No. Not me. I do not say anything before I have scientifically confirmed my facts. The sequence of events was this. Ramesh had visited her flat last night. Apparently the meeting was aimed at reconciliation. Ramesh wanted to explain Seema the circumstances under which he was marrying elsewhere. The fact of his visit last night is confirmed by Seema's neighbors. Even Ramesh himself has agreed to this fact. Apparently, he stayed there for about 15 minutes and then left. Sometime after he left, Seema knocked at a neighbor's door and told her she was not feeling well. She was sweating profusely, had very high fever, complained of intense thirst, and was in great distress. The neighbors immediately realized that something was terribly wrong with her. They took her to the nearby hospital. Before the doctors could ask her anything, she fell into a coma, from which she never recovered. She died after 6 hours." "Oh, I see. So how did she die? "I will tell you about that a little later, when I tell you about my scientific deductions. But before that, it would be very necessary for you to know, why this case has been brought to me. Her parents were immediately informed by the neighbors and they have arrived this morning. After hearing everything, they have put a very damning allegation on Ramesh. They say that last night during his visit, Ramesh must have given her something to eat because of which these symptoms started. The fact that the symptoms started just after Ramesh left has given credence to this allegation. The police also believes this theory. They think that Ramesh wanted to get rid of Seema, otherwise she could have made life hard for him. She could even have kept troubling him after marriage, and could even infuse all kinds of doubts in the mind of his future wife, so the best course for Ramesh was to put an end to her life." "What does Ramesh have to say in this regard?" "The police has enquired Ramesh, and he says that he did visit Seema to explain her his position. The marriage was being held at the instance of his parents, and he could not interfere in that. But Seema was not ready to listen to him. She was very depressed. After about 15 minutes of unsuccessful attempts at reconciliation, he left." "What do the doctors at the hospital say about the cause of her death?" "The doctors did not have much time to examine her. I have talked to the doctors there. They feel it could be a case of salicylate poisoning or perhaps even thyrotoxicosis." "I don't really understand these two terms. Please explain them to me." "Tarun, acetylsalicylic acid is used in modern medicine for the relief of pain. Ordinary dispirin, which is available in the market for pain relief contains 350 mg of acetylsalicylic acid. If too many tablets are ingested, one can get salicylate poisoning. The toxic dose of acetylsalicylic acid is about 200-300 mg/kg. Thus you can plainly see that for Seema who was 76 kg, the toxic dose is about 65 tablets. People may ingest pain killers for committing suicide. This practice although very common in foreign countries, is not so common in our country, mainly because people are not aware of this fact. But Seema was an educated girl, and she might be well aware of this fact. She was depressed because of recent developments and she might have ingested these tablets after Ramesh left. Ramesh obviously could not give her so many tablets to eat, and even if he had given her, she would not have eaten them. So if this case does turn out to be that of salicylate poisoning, it is quite probable that Ramesh is indeed speaking the truth, and had nothing to do with her death." "Why did the doctors at the hospital think in the first place that she was having salicylate poisoning?" "Because of her symptoms. The symptoms of high fever, thirst and profuse sweating are seen in salicylate poisoning. It might surprise you to know, that although acetylsalicylic acid is normally used for the control of high temperature, during overdose, it produces high fever itself. The doctors also noted difficulty in respiration and very rapid heart rate. Before she went into coma, she also had convulsions. These features are quite typical of salicylate poisoning. The same features are also seen in thyrotoxicosis, a disorder of the thyroid gland, in which the thyroid starts secreting excessive amounts of thyroxine. That is why the doctors gave this as the second diagnosis." "Oh, so now we have all the views. Now tell me what your investigation reveals." "Tarun, we can straightaway rule out thyrotoxicosis. In this disorder, the person is excessively lean and as you can see, Seema is very much overweight. Acetylsalicylic acid poisoning seems a more likely choice. But when I examined her hands, I found some yellow stains on them. This, and certain other findings, which I shall explain shortly, immediately alerted me in the direction of another poison- a very rare one, but one which causes exactly the symptoms exhibited by Seema" "What is that poison doctor? Please tell me. I am getting curious." "Tarun it is known as DiNitroOrthoCresol or DNOC for short." "DNOC? Never heard of this poison. Please tell me something more about this poison." "Tarun, DNOC belongs to a family of compounds known as dinitrophenols (DNP). These compounds are highly toxic and can rapidly produce death. Toxic effects often appear at blood concentrations greater than 30 mg/l while concentrations greater than 60 mg/l are associated with severe toxicity. Dinitrophenols are mainly used as pesticides. Dinitro-ortho-cresol (DNOC) and Dinitrophenol are the two main phenolic pesticides. These substances are used in agriculture chiefly as selective weed killers for cereal crops and for the destruction of potato haulm. In dilute solution they may be used as an insecticidal winter wash for fruit trees. The principal risk of poisoning is in the agricultural use of concentrated solutions for spraying crops. Absorption occurs by inhalation and ingestion and also through the skin; excretion is extremely slow so the poison tends to accumulate in the body. The risk of absorption is much greater during hot weather. Those exposed to these chemicals (such as farmers when spraying these chemicals) are generally recommended to wear respirators to avoid inhaling them. They are also subjected to periodical examination to determine the concentration of these compounds in the blood, which should not exceed 20 micrograms per gram. Dinitrophenolic compounds, especially DNOC stimulate the human metabolism very strongly. In fact DNOC can increase the tissue metabolism by 1200%! The effects of dinitrophenol in stimulating metabolism have been known since 1885, and at one time DNOC was even used in the treatment of obesity and misused for "slimming". "I couldn't understand that last point very well doctor." "Tarun, any compound which stimulates metabolism that greatly basically burns up your energy stores in the body. The main energy store in the body is the fat. If it is burnt, the person will get slim. All exercises are aimed at this only- to burn as much fat as possible. But exercise is time consuming, boring and exerting, so people are on the lookout for easy way out such as chemicals and drugs which can either reduce appetite or enhance metabolism, i.e. help burn up excessive fat. For the former effect, drugs known as amphetamines were once very popular, but they have lost favour as their side effects are too many and too serious. DNOC stimulates metabolism by as much as 1200%, i.e. it burns fats 12 times faster than in a normal man. Obviously this will form a good candidate for weight reduction." "Then why don't doctors prescribe it for weight reduction?" "Because it is a very toxic drug. But early in the century several people did take it for the reduction of weight. When fatalities started occurring, the doctors came to know about its serious toxic nature, and they advised the people against taking this drug. But it was commonly available, as it was a herbicide, so people purchased it with impunity and many overweight girls are known to have consumed it in an attempt to become slim overnight. But in fact nothing of that sort happened. They died instead. Following the deaths of several girls in this way, the availability of this drug was restricted to certain people only. But still many people can get hold of this drug and may consume it. You may be surprised to know that today DNP and DNOC can be illegally bought over the internet too! Many gullible youngsters who fall prey to these internet advisers are paying with their lives. These internet advisers are quacks who encash upon the gullibility of such youngsters. They claim that their concoction would cause a quick weight reduction, but it doesn't. It kills them instead. DNOC is about 5 times as potent as dinitrophenol. The characteristic effect of these two drugs is the uncoupling of the oxidative phosphorylation, causing a great increase in tissue metabolism......" "Sorry to interrupt you doctor. You just talked about uncoupling of oxidative phosphorylation. I don't understand this term quite well. Can you explain me please?" "Tarun, this is a technical term the details of which I may not be able to explain in such a short discussion. But I will tell you certain basics. When glucose is burnt in the body to carbon dioxide and water, it passes through 3 stages. The last stage is technically known as oxidative phosphorylation. During each stage some energy is liberated, which is stored in the form of ATP (Adenosine TriPhosphate) molecules. DNOC and other dinitrophenolic compounds inhibit the formation of ATP molecules, without inhibiting the process of oxidative phosphorylation. This means that although body is burning glucose continually, it is not getting any energy in the form of ATP molecules. This situation when energy is being produced, but is not available for the formation of ATP molecules is technically known as uncoupling of oxidative phosphorylation. This excess energy has to be dissipated in the form of heat. That is why patients poisoned by this poison show high body temperature and sweating. Since body is not getting adequate amounts of energy, it tries to burn more and more glucose in a futile attempt to get energy. Even fat stores are mobilized, but all the energy produced is dissipated as heat. This is the basis of increase of metabolic rate by these compounds." "Oh, I see. But the symptoms are also seen in salicylate poisoning. How did you know she had taken DNOC?" "By the yellow stains on her hands. This yellow staining is very typical of dinitrophenolic compounds. When these compounds come in contact with skin, they form trinitrophenol or picric acid, which is yellow in color. By the yellow stains on her hands, I immediately realized that she must have handled dinitrophenol compounds. I believe she was quite concerned about her weight, and was taking this compound reqularly in small doses. I do not know where she procured this compound from, but probably she must have contacted one of those quick weight reducing quacks, who must have given her this compound. When she was taking small doses, nothing dangerous happened. But due to recent developments, she was quite convinced that she had lost Ramesh because of her weight problem. In a bid to overcome her weight problem overnight, she must have tried to get at it in one go, and may have consumed a great amount of drug immediately after Ramesh left. That is how the symptoms appeared." "But how are you sure, Ramesh did not administer her this drug?" "Because of this drug's peculiar color, odor and taste. No one can administer this drug to another by deceit, without the other immediately coming to know about it. I have exmained her blood and have found high amount of DNOC in her blood. The levels are about 100 mg/l, which is surley a fatal level. Subsequent to this, I asked the police to search her house and look for all medication bottles there. Normally the police would never have even peeped there. But following this discovery, they looked at her almirah and did indeed find a medicine chest. They brought her entired medicine chest. I noticed 3 suspect looking bottles and put their contents to examination, and in one of these, not very surprisingly, I did find high amounts of DNOC. The police have noted the name and address of the doctor from the label of that bottle, and a party has been despatched to UP to arrest that doctor. It appears that the quack who prescribed this medicine to her is based in UP, and during one of her visits to her parents, Seema must have picked this medicine." "Oh, how very clever of you doctor. Without your clever deduction, poor Ramesh would have unnecessarily been arrested and implicated. This was a most interesting discussion. Tell me what are you going to tell me the next time?" "Tarun, next time, I would tell you about a very interesting poison- Cadmium."